Report on the state of play of the the European Union · Report on the state of play of the...

Report on the state of play of the

deinstitutionalisation process and the

development of community-based Care in

the European Union

The European Expert Group on Transition from Institutionalisation to

Community-based Care

July 2016

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European Expert Group on Transition from Institutional to Community-based Care

The European Expert Group on the Transition from Institutional to Community-based Care

(EEG) is a broad coalition gathering stakeholders representing people with care or support

needs and their families, including children, people with disabilities, homeless people,

people experiencing mental health problems; as well as service providers, public

authorities and intergovernmental organisations.

The Group has as its mission the promotion of person-centred, quality and empowering

models of services and formal and informal care that fully respect the human rights of all

people with care or support needs. The Group supports national efforts to implement the

necessary reforms, in compliance with the United Nations Convention on the Rights of

Persons with Disabilities (in particular with Article 19), the United Nations Convention on

the Rights of the Child and the European Fundamental Rights Charter.

The Group provides expert support on EU policy, legislation and funding. All members of

the Group provide a link to operational expertise at national, regional and local level

through their direct involvement and the empowerment of their member organisations.

Date of publication: June 2016

Publication coordination and layout: Charlotte Portier

© EEG 2016 – European Expert Group on Transition from

Institutional to Community-based Care

Front Picture, © European Union, 2016

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TABLE OF CONTENTS

Introduction P. 2

Collection of country fiches P. 3

Austria P. 4

Bosnia Herzegovina P.6

Bulgaria P.7

Catalonia P.9

Czech Republic P.11

Denmark P.13

England P.14

Estonia P.16

Greece P.18

Hungary P.20

Ireland P.22

Lithuania P.24

Moldova P.26

Poland P.28

Serbia P.30

Slovakia P.32

Slovenia P.34

Conclusion P.40

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The European Expert Group on Transition from

Institutionalisation to Community-based Care has

collected this past year country fiches of the

European Union’s member states in order to draw a

state of play of the implementation of

deinstitutionalisation.

This report reveals the findings and underlines the

main challenges encounter by the different country.

The analysis is based on the following elements:

Legal and policy context

EU structural funds

Progress toward DI

Support in the community

Involvement of users

It appeared to the EEG that a lack of communication

and exchanges between grassroots level and

national/European level exists leading to a lack of

understanding and knowledge. For this reason, we

have launched this collection.

The challenges and issues encounter while

transitioning from institutional to community-based

care are very different from one country to another.

For this reason, particular attention must be given to

the specific context when assessing the state of play.

The data available and the findings differ from one

country to another and the results may not always be

comparable. However, this report constitutes a good

source of information and will keep being updated. .

INTRODUCTION

2

ACKNOWLEDGEMENT

Many organisations participated to the draft of

the report and we would like to warmly thanks

them for the time and effort they dedicated to

it.

Jane Snaith (MTÜ Igale Lapsele Pere), Irina

Malanciuc (Lumos Moldova), Regina Bisikiewicz

(Open Dialogue Foundation), Unicef Bulgaria,

Dr Joanna Robaczewska, Pordán Ákos (Hand in

Hand), Mencap UK, Maria Holsaae (Danske

Handicaporganisationer), Ferran Blanco

(Fundacio Tutelar), Mental Health Ireland,

COFACE (Confederation of Family Organisations

in the EU), EASPD (European Association of

Service Providers for People with Disabilities),

EDF (European Disability Forum), ENIL/ECCL

(European Network on Independent Living/

European Coalition for Community Living), ESN

(European Social Network), Eurochild, FEANTSA

(European Federation of National Organisations

Working with the Homeless), Inclusion Europe,

Lumos, Mental Health Europe, as well as the

United Nations‘ Office of the High

Commissioner for Human Rights – Regional

Office for Europe and UNICEF.

Glossary

Deinstitutionalisation: It is the full process of planning transformation, downsizing and/or closure of residential

institutions, while establishing a diversity of other child care services regulated by rights-based and outcomes-oriented

standards

Community-based Care: It refers to the spectrum of services that enable individuals to live in the community and, in the

case of children, to grow up in a family environment as opposed to an institution. It encompasses mainstream services,

such as housing, healthcare, education, employment, culture and leisure, which should be accessible to everyone

regardless of the nature of their impairment or the required level of support.

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Collection of country fiches

Analysis of the implementation of

deinstitutionalisation & the development

of community-based Care

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4

AUSTRIA

Legal & Policy Context

Monitoring bodies

Children

The Federal Ministry for Family and Youth installed a

Monitoring Board for Children’s Rights as an independent

advisory body. The Monitoring Board for Children’s Rights

comprises child and youth advocacies from the states,

representatives of the Network for Children’s Rights and

renowned experts in their fields of child and adolescent

psychiatry, youth surgery, demographics, pedagogues, law

and youth welfare.The installation of the Monitoring Board

on Children’s Rights has created a permanent mechanism

for coordination, drawing on a line of experts from diverse

fields (health care, law, new media and more), the child

and youth advocacies of the individual states and related

NGOs as well as involving ministries and state governments

and is not merely a symbolic gesture, but a pragmatic step

towards the full implementation of the Convention on the

Right of the Child in Austria”(3).

People with disabilities and People with mental health

problems

The Federal Disability Act) establishes a Monitoring

Committee that monitors the domestic implementation of

the Convention on the Rights of Persons with Disabilities.

According to the Federal Disability Act the members of the

Committee must be independent and may not be bound by

any directives and orders. (4) In some of the Länder

monitoring committees have been established as well: So

in Vienna, Tirol, Lower Austria and Upper Austria. It has

been criticised that regional Monitoring Committees as

well as the national one don’t adhere to the Paris

Principles. (5)

In an amendment to the Federal Disability Act, an

Ombudsman for the Equal Opportunity of People with

Disabilities (Disability Ombudsman) was created. The

Disability Ombudsman is responsible for providing advice

and assistance to persons who feel discriminated against

within the meaning of the Federal Disability Equality Act or

according to the prohibition of discrimination in the

Disability Employment Act. (6)

EU Structural Funds

The ESF budget for Austria 2014-2020 amounts to 442 Mio.

EUR plus co financing through national partners (1). The

partnership agreements between the EU and Austria

contain horizontal principles amongst them accessibility

and non discrimination of people with disabilities.

According to ÖAR the main challenges are the lack of

controlling/monitoring mechanisms and hence the

implementation and enforcement of these principles. The

Federal Ministry of Labour, Social Affairs and Consumer

Protection (BMASK), Unit VI/9, is responsible for the

overall coordination of the ESF in Austria (2).

Progress toward DI

Children

The transition from large institutions to smaller forms of

care is not completed. The City of Vienna has set the

agenda with its program „Heimreform 2000“ that intended

to replace all large residential homes for younger people

radically towards decentralised residental groups (still)

with a maxiumum of 8 inhabitants. Also in the other Länder

the process is in progress. According to the „principle of

Life-Space“ children should be accommodated close to

their community of origin. This principle has been adopted

in the operative work of the child and youth services. Still

not included in this principle are children with disabilities.

The City of Vienna has set the agenda also in this matter

having closed large residential homes for younger persons

with disabilities. In the rest of Austria there is no

consensus, that the children and youth services are

responsible for all of the children. In Lower Austria for

instance the matters of children with disabilities are still

handled by 2 divisions.

The federal Ministry for family and youth is responsible for

the frame of DI for children and youth. The 9 provinces

(Länder) are responsible for the implementation. There is a

long and extended culture of residential care.

Context

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Collection of country fiches: Analysis of the implementation of deinstitutionalisation

5

Lobbying for DI seems a little bit blocked by care providers.

On the other hand in each federal country there is an

“ombudsman” for children. These ombudsmen could play

an important role to provide political exchange and

influence towards DI.

Challenges DI for children: Inclusion of children with

disabilities and mental health problems, Support of

vulnerable children and young persons showing

behavioural problems/criminal offenders. Beyond projects

there is still not enough collaboration between children and

youth services and justice., Support of underage asylum

seekers, there are merely no care centres, Promoting and

building up a professional system of foster-parenting as an

alternative to residential care, Care centres for children

with psychosocial disabilities are very rare; Working on

unified, national standards for residential care.

People with disabilities

“In Austria, human rights of persons with disabilities are

neither recognized nor guaranteed in various areas. Thus,

the shift of paradigm as stipulated in the CRPD has largely

not been realized in Austria (e.g. an indicator for this is that

it is still the Ministry for Social Affairs, which is mainly

responsible for the Federal Government’s obligations

towards persons with disabilities). Comprehensive

accessibility (physical, intellectual, social and

communicative) is lacking. Inclusion of persons with

disabilities in the area of education and work is not

ensured. Moreover, measures to realize independent living

are lacking.”(7)

It appears that very few development have been made

since the last UNCRPD recommendations. “The segregating

system continues unabated, reforms towards inclusion,

accessibility, self-determination and participation remain

limited half-heartedly as before or pilot projects. There are

also setbacks (e.g. in education and in the area of

accessibility). For people with disabilities directly and

existentially important issues such as personal budget,

personal assistance, de-institutionalization and supported

decision-making are not or not sufficiently regulated by

law. (8)

The Austrian National Council of Disabled Persons (ÖAR)

criticizes that there is no systematic coordination system of

data collection in the field of disability services. The

national report instead provides a set of examples of types

of services provided across the different provinces. Data on

types, size and residents of institutions would be necessary.

The strategy of the Austrian federal government for the

implementation of the CRPD is written down in the NAP on

disability 2012-2020. The NAP covers DI only in one

passage: “In the field of housing, a comprehensive de-

institutionalisation programme is necessary in all nine

Länder. In this process, large institutions need to be broken

down and at the same time support services created which

also enable people requiring a high level of support to lead

an independent life in their own homes. The principle has

to be that those affected can choose the form of housing

which suits them and the support services they need.” (9)


In the aspect of DI Austrian NGOs see personal assistance

as an important alternative to institutional segregation of

people with disabilities. In Austria concepts and programs

for the depletion of institutions and for the composition of

community based support systems are lacking.

Involvement of Stakeholders

Involvement of persons with disabilities in Austria are

organized in numerous groups and organizations, which

nonetheless are mostly confined to urban areas. Apart

from ÖAR (Austrian National Council of Disabled Persons)

there are independent Living Groups and various groups of

persons with disabilities. Also, organizations of the church

such as Caritas or Diakonia participate in policy discussions

regarding persons with disabilities.

Although in Austria persons with disabilities and their

representative organizations are invited to comment on

reviews of laws or other measures, frequently their

comments are not taken into account. This is either due to

opposition of the rather influential Austrian commerce

sector or for reasons of supposed lack of funds. Therefore,

equal participation in all areas of society, as enshrined in

the CRPD, has in fact not been realized in Austria.

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BOSNIA HERZEGOVINA


The following policies relate to DI. There are no specific

legislation as such and there is no coordinating structure at

any level.

Policy for the Protection of Children Deprived of

Parental Care and Families at Risk of Separation in

FBiH, 2006-2016

Republika Srpska Strategy for Enhancement of

Social Welfare of Children Without Parental Care,

2015-2020

Strategy for deinstitutionalisation and

transformation of institutions in Federation of BiH,

2014

Strategy for Equal Opportunities for Persons with

Disabilities in FBiH 2011-2015

Strategy on Enhancing the Social Position of Persons

with Disabilities in RS 2010-2015

Legal Capacity

Decision to deprive or revert legal capacity may be

appealed by any person who participated in the

proceedings within three days of receipt of the decision.

The person whose legal capacity has been taken away may

appeal regardless of their health status. The appeal does

not stay the execution of the decision, unless the court for

good cause, decides otherwise. Court of First Instance will

appeal to the writings without delay to the appellate court,

which is obliged to decide within three days after receiving

the complaint. (10)

Inclusive education

Inclusive education is foreseen by local education laws.

However, implementation is lagging behind, largely due to

lack of funds to train and hire sufficient number of

individual assistants in schools.

Budget allocation

No mechanisms to re-route funds exist. Allocations for

development of community based services are allocated

from cantonal, and municipal budgets to a minor extent,

and largely supported through international projects.

EU Structural Funds

Progress toward DI

Data

There are approximately 1,000 children without parental

care in institutions and approximately 600 children with

disabilities in institutions. About 1,700 adults with

disabilities are in institutions.


Different types of support in the community exist, such as

day centers, assisted living, early intervention programmes,

counselling services provided by NGOs – however mainly

only present in larger, urban centers. These types of

services largely depend on donor funding, only few actually

integrated in the system.

Involvement of Stakeholders

Some examples

Family support programme – Hope and Homes for

Children: supporting families at risk of separation,

involvement of all relevant stakeholders in the community

Young adult support programme – Hope and Homes for

Children: supporting young adults leaving public care on

their road to independence, involvement of all relevant

stakeholders in the community

Assisted living in the community for persons with

disabilities – SUMERO Alliance for support to persons with

intellectual difficulties, involvement of relevant entity and

cantonal ministries of social welfare, centres for social

work

Early childhood development centres – UNICEF

Drop-in centers for street-involved children – Save the

Children

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BULGARIA


UNCRPD

The coordination for its implementation is delegated to

MLSP. Ministry of Labour and Social Policy leads the policy

for people with disabilities and the Minister is the

Chairman of the National Council for the Integration of

Persons with Disabilities (NCIPD). Two Action Plans for

implementation of the UNCPRD were approved by the

Council of Ministers, i.e. covering the periods 2012-2014

and 2015 – 2020. The plans are focused on art. 12, art. 19

and art. 27. According to local organizations the plan is not

ambitious and will not lead to substantial changes. A

special body – Agency for people with disabilities is

responsible to support the national policies for people with

disabilities.

Legislation

All social services are regulated by the Social Assistance Act

and its Implementing Regulations . (11) In addition, social

services for children are also discussed in the Child

Protection Act (12). Both acts stipulate the use of

institutional care as a last resort.

In January 2016 the Parliament adopted amendments to

the Social Assistance Act with relation to the access to

community based services. The amendments include:

- the definition of the objective of social services is

improved and they are aimed to support the social

inclusion]

- new obligatorily assessment is added to the medical

expertise;

- the persons under guardianship receive the right to be

hearth about their willingness what service to use.

Still the list of social services in the SAA is too limited as

possibilities for independent life and too conservative as

approach. Despite the good practices there is no

legalization of home based support for elderly people,

persons with disabilities and health problems and for

persons with mental health problems .

Strategy

Relevant strategic documents are:

- National Strategy for the Child 2008 – 2018 adopted by

the National Parliament

- National Strategy Vision for De-institutionalization of

Children in Bulgaria 2010 – 2025 adopted by the

Government on 24 February 2010

- National Strategy for Long-term Care adopted by the

Government

Currently a new Action Plan for the implementation of the

Vision for DI as well as a new Concept and Action Plan for

DI in the Ministry of Health are being developed. Ministry

of Labour and Social Policy is currently developing a plan

for DI of care for elderly and people with disabilities 2016 –

2020 . There is idea on strategical level to close institutions

for adults but there is no plan to improve substantially the

quality of live there in the meantime. The rules for

delivering support in specialised institutions are not

improved in the line with UNCHRPD. Drafts of strategies for

implementation of art. 1, 2, 12 and 19 of UNCRPD are

under preparation.

Legal Capacity

There are good practices in the country piloting new

approach - Supported Decision Making which supports

people to follow their own decisions and will and to keep

their civil rights. Recent monitoring of the conditions in

the specialised institutions conducted by Helsinki

Committee shows that for the persons placed in

institutions there is no difference if they are under

guardianship or not, as for all the residents the

fundamental and civil rights are not fulfilled.Under

preparation is a new act according to the art. 12 of the

Convention which is directed to introduce a new form of

support for persons with intellectual difficulties and mental

health problems regarding their civic participation and civil

rights. The new act aims to eliminate the existing full and

partial guardianship for people with mental health

problems. The new act was elaborated by Ministry of

Justice and it is expected that will be adopted.

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Inclusive Education

In September 2015 the National Assembly adopted a new

Law on pre-school and school education. which reinforces

the right of every child with disability to receive education

in the mainstream system, and establishes the necessary

institutional arrangements to support inclusive education.

It also envisages special schools (with the exception of

schools for children with visual and hearing impairments)

to be closed and transformed within 1 year after the law

enters into force into Centers for specialized pedagogical

support. At present the country is developing a Standard on

inclusive education which will further develop the national

framework on inclusive education. (13)

Budget allocation

Social services are funded mainly by: Subsidies from the

state budget to the municipalities and local revenues of the

municipalities The total planned subsidy from the state to

the municipalities for provision of social services

(residential and community-based) for 2016 is almost 100

million Euros.

Re-allocation of funds from institutional to community-

based services is performed by the Agency for Social

Assistance in any case of reducing the capacity or closure of

an institution with corrections to the budgets of the

municipalities. There is no mechanism for re-allocation of

funds in the case of closure of Infant Homes, which are

managed by the Ministry of Health.

EU Structural Funds

Progress toward DI

Children

The number of institutions and institutionalized children in

the country was significantly reduced since 2010. During

2015 alone 31 institutions for children were closed. The

number of institutions and children placed in them since

2010 was reduced. (14)

Adults

The process of elaboration of the first plan for DI for adults

has just started. It includes development of new residential

services with a capacity for 20 people located more or less

in the same localities as the existing institutions (small

towns and municipalities with very limited number of

population and with explicitly written intention to involve

the same personal in the new services). The plan so far

does not include measures for training and capacity

development and the functional requirements for the new

residential services copy the structure of the specialised

institutions with the limited personal space, no access to

domestic activities and kitchen and with no space for

activities by interest and in small groups. The proposal

faces a strong opposition from the NGOs.


Training of professionals

Training of professionals was part of national DI projects

for children, however it was very limited in terms of

duration. 4621 professionals were trained under the DI

projects for children in the period 2010 – 2015 (data

provided during a seminar organized by UNICEF and the

State Agency for Child Protection in January 2015). Training

for staff in new services is planned to continue with EU

funds. There is no nation wide system for capacity building,

training and supervision to professionals.

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9

CATALONIA


There isn’t specific legislation which contemplates a full

transition from institutionalised care to community-based

services/care. There’s, at best, an approach towards

deinstitutionalization in the National Health Strategy and is

not fully legally binding and varies depending on the region

if the autonomic region has competences on the subject

(for example Catalonia have competences in health, social

services and the law system) so it focuses to develop a

more progressive approach towards the transition from

institutionalized to community-based care than the rest of

Spain, or at least, it works different.

Two important legislation concern community based care:

- Ley 26/2011 normative adaptation to the Convention on

the Rights of Persons with Disabilities). Basically this law, as

a general rule, recognises several principles: respect to the

dignity, the right to independent living, equality of

opportunities, non-discrimination and universal

accessibility. It applies to: telecoms, information, public

spaces, infrastructures, transportations, goods and

services, relations with the public administrations, justice

administration, cultural heritage and labour. It was born to

ensure protection in all spheres of an individual’s life.

- Real Decreto Legislativo 1/2013 de 29 de noviembre,

approves the revised text of the general la won the rights

of persons with disabilities and their social inclusion). Its

objective is to guarantee the right to equal opportunities

and treatment of individuals with disabilities as well as the

real and effective exercise of rights of persons with

disabilities as the Spanish Constitution and the CRPD

recognises. It also establishes a regime of sanctions and

penalties in case of infringement.

DI is highly encouraged in national health strategies,

especially in our region, which embed in its objectives

deinstitutionalization as a strategic line or objective to

achieve in subsequent years according to the integral

action plan for people with mental health impairments and

drug addiction

Inclusive education

In Catalonia, there are opportunities for people with

disabilities to enjoy the right to education in a non-

segregated centres (even though segregated centres exists

as well as special education centres) in all stages of an

individual education: childhood, primary and secondary

education (mandatory) and post-obligatory education. Its

implementation depends on economic resources of the

centre and the form of support the person need previously

assessed in an individualised curricular plan elaborated by

the CAD (Diversity Attention Commission). The CAD is a

special commission inside the school integrated by the

management team, teachers specializing in attention to

diversity (special education teachers, counsellor of the

centre, therapeutic education teachers, psycho-

pedagogues and the studies coordinator).

Budget allocation

Community-based services are publicly underfinanced

given that demand of those services exceeds its public

offer. Community-based services are offered mainly by the

Social Service System through its Portfolio of Services

(detailed later) and to a lesser extent by the Health Care

System, still highly dependent on hospital settings and

institutions to offer attention to its users.

However, in our region, there’s a trend towards

decentralizing mental health services from the hospital

which in practice translates into mobile teams (mainly

psychiatrists) that visit patients in its home. However we

can’t provide specific data or asses its effectiveness and

impact because it’s in a pilot stage.If you are not eligible to

enjoy a publicly concerted service you need to contract it

in the private sector; people with complex needs and with

complex situations due to disabilities receive welfare

benefits, albeit the monthly income proceeding from

benefits is generally lower than minimum wage. In that

situation, an efficient use of resources alongside with high

doses of creativity is required to enable an individual to

enjoy independent living or support in the transition to

institutionalized care to community integration

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EU Structural Funds

Progress toward DI


In Catalonia, institutions and services available are offered

– and subsequently are dependant – either through the

Health Care System or through the Social Services System.

The Portfolio of Social Services (in form of resources,

institutions and services) available is organized by

categorizing its user base in different typologies. The

following data is extracted from the Specialised Social

Services Report and it comprises the entire Catalonian

territory (divided by its 4 regions: Barcelona, Girona, Lleida

and Tarragona).

Elderly People

Assisted-living facilities. (+65 years. 24/7). 997 Equipment

& Services

Day-care centre. (+65 years). 880 Equipment & Services

Supported Housing. 50 Equipment & Services

Long-stay socio-sanitary centre. 100 Equipment & Services

Day-care hospital. 73 Equipment & Services

House assistance services. 102 Equipment & Services

Intellectual Disabilities

Occupational Centres.264 Equipment & Services

Specialised day-care centre. 44 Equipment & Services

Residential centres. 91 Equipment & Services

Residential homes. 236 Equipment & Services

PSALL (Autonomy support in an individual’s home). 71 Equipment & Services

Physical Disabilities

Occupational Centres.19 Equipment & Services

Specialised day-care centre. 13 Equipment & Services

Residential centres & Residential homes. 27 Equipment &

Services

PSALL (Autonomy support in an individual’s home). 13

Equipment & Services

Personal Assistant. 8 Equipment & Services

Psychosocial Disabilities

Residential centres. 39 Equipment & Services.

Supported Housing. 94 Equipment & Services

Pre-laboral Service (Guidance, formation and training). 39


Social Club. 52 Equipment & Services

PSALL (Autonomy support in an individual’s home). 35



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CZECH REPUBLIC


There is a new government from November 2014. All DI

plans started by previous governments formally continue,

but leadership is not so visible. For example the MoLSA

deputy minister responsible for social services is openly

supporting idea of refurbishing of institutions as alternative

to DI process.

EU Structural Funds

OP are in process to be agreed. It is calculated with a

special program for transformation of menta health care,

special programm for continuity of transfromation of social

care homes and there are special programs for the reform

of institutional care for children. All together for DI project

is planed about 300-400 million Euro. The partnership

agreement targets early-childhood education and care

services (by increasing offer and ensuring quality),

including integrated approaches combining childcare,

education, health and parental support, with a particular

focus on the prevention of children's placement in

institutional care. Support the transition from institutional

care to community-based care services. Ministry of

Regional Development (investments), Ministry of Labour

and Social Affairs are the structure managing the funds.

Currently there are a considerable number of projects and

measures which are financed through ESF and ERDF. We

have on-going projects and a new call for proposals for

regions and social service providers for:

- support of new community-based social services;

- community planning;

- process of de-institutionalisation etc.

Progress toward DI

Although in recent years can be seen various positive

efforts , the deinstitutionalisation process in the Czech

Republic has been slow and unsatisfactory. The number of

people with disabilities in residential care has only slightly

decreased. Most of policy documents and pilot programs

do not have a clear plan for continuation.

Data

In a year of 2013 there were 418 residential care homes for

people with disabilities (18 beds and more) , with total

capacity 16.000 beds, of whom 1.045 are children with

disability. In recent years, there is significant growth in

number of care homes with “special regime” – these are

mainly used for people with dementia and for people with

challenging behaviour (incl. people with autism, mental

health issues etc.). Number of people in these institutions

is about 8.000. There are about 38.000 older people living

in residential care homes as well.

In 2012 there were under the health resort 33 institutes

for infants and homes for children up to 3 ye. Capacity of

these institutes was 1 700 places and at the end of year

there were placed 1 397 children. Under the education

resort there were 6 941 children in children homes. There

is 9 300 beds in psychiatric hospitals. About 3 000 beds

are for long stay clients, rest of this capacity is for acute

admission and short stay clients.

Project

Ministry of Labour and Social Affairs has begun in 2010

implementing a project of deinstitutionalisation (called

"Support for the transformation of social services") in the

framework of the EU Integrated Operational Programme

with a budget of EUR 56 million. The aim of the project was

to support the transformation process of residential social

care, by validating pilot transformation of social care based

on individual users' needs for social services. Individual

projects have received 100% funding of the total cost.

32 institutional facilities across Czech Republic have been

involved in this project. They provide services for

approximately 3 800 persons with disabilities. Again no

further plans are proposed or designed with those

institutions. The project’s goal was to conduct a pilot test

of deinstitutionalisation, including comprehensive plans,

staff training, and assessment of service users’ needs. By

creating networks of group homes in the community, these

initiatives should reduce the capacity of large institutions

and lead to deinstitutionalisation.

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12

This programme was focused on the entire territory of the

country with the exception of the capital city of Prague.

There is no interim report available on the progress of the

project so far.

In March 2013, the project Support of the Transformation

of Social Services ends. However, evidence suggests

worries regarding the shortage of national resources for

the new residential social services after the completion of

the EU project.

As of end of 2013, thanks to this project 544 people with

disabilities left institutions to live in new conditions: 130

went on to live with their families, friends. 414 lives in

community based social services.

Main issues following DI of social services for people with

disabilities:

- in some of those 32 institutions, the transformation

process will not be finished by end of 2015 due to lack of

finances (e.g. Pata Hazlov) or troubles within the

administrative process and/or resistence from local

communities (Domov Sluneční dvůr, Jestřebí)

- part of ESF money which is being used for

“transformation” creates new or rebuilds existing

institutions – esp. regional operation programmes which

lack clear guidelines on DI (see Domov Beruška, Ostrava)

- transformation activities lead mostly to the creation of

group homes (with up to 18 people), while individual

solutions are limited

- no clear guidelines for new ESF programming period

regarding the type of services that may get funding –

MoLSA states preparation of new criteria; so far, there are

no documents and Integrated operational programme

states it is possible to finance “humanization” of existing

institutions.

Children

On 19 January 2009, the Government addopted the

document "Draft of transform of the system of care for

vulnerable children - the basic principles. Interagency

coordination was established. Later on in 2009 Nationla

Action Plane of Transform and Unify the System of Care for

Vulnerable Children was addopted.

There is certain progres and number of capacities in

institutional care for children is slidelly reducing. But the

current system of care for vulnerable children i is still very

complicated and confusing. The topic of vulnerable children

directly addresses five ministries. Children institutions are

in charge of three different ministries. Coordination of

activities of all these departments and agencies under

these ministries operating is insufficient.

Persons with psychosocial disabilities

In 2013; the Ministry of Health accepted a document „

Strategy of the reform of psychiatric care“. Although this

document have main aim to improve quality of life of

people with psycho –social disability, the document is

rather general and transformation of institution to

community based care is not mentioned. The process of

detailing a strategy and preparation of pilot project are in

progress.

Although there is a plan of transformation of institutional

care Norwegian funds are actually used for refurbishing

institution to create better condition for “rehabilitation”

and preparation of clients for discharge. In some hospitals

this funds are used for building up “ training housing”

within hospital premises.

Homelessness

In relation to the homeless people, the housing-led

approach is not well developed. It is very difficult for

people to progress from shelter use into an apartment.

There is no comprehensive system of social housing, or

housing assistance. Some cities provide some form of

housing according, but other cities have sold almost all

apartments into private ownership or cooperatives during

the transition from communism. A comprehensive strategy

document for combating social exclusion for the period

2011-15 refers to social housing (emergency housing/

shelters, temporary accommodation, training housing, and

long-term social housing /housing).


Several legislative proposals on Social Services. have been

submitted, aiming to introduce:

-new principles of using social services: firstly by referring

to mainstream services and resources in community,

secondly to field and ambulant social services and at last to

residential community-based services;

-new measures, i.e., in community planning and referring

to the obligations of the social services providers,

If accepted, the proposals should be incorporated as

amendments to the Act of Social Services. One proposal

has been accepted so far – sheltered housing cannot be

attached to/take place in institution or on its grounds.


15

13

DENMARK


The law on Social Service was changed in 1998 where the

concept ‘Institution’ was taken out of the law. That meant

that Housing under the Social law is by law separated from

the personal support given by Social law. However, even

though institution is formally not a part of the law, in

practise some Municipalities connect support with housing

and thereby we do see some institution-like constellations

on the practical level. Housing under the Social law is

primarily for people with LD or intellectual disability.

There is no National strategy for DI. In relation to children

it has been a tradition for many years that children live at

home if at all possible and legislation gives different

possibilities for the parents to get support at home.

Inclusive education

A new law was implemented in xx with the goal of

including 96 % of children with disability in primary school.

Due to how this was done in practise, the Government has

just decided to abandon that goal. However 95,2 % of

children with disability is now included due to the former

legislation and 4,8 % is in special schools.

Budget allocation

Since Institutions is formally nonexistence in law, there are

no mechanisms to re-route money.

EU Structural Funds

Progress toward DI

Data

There are no data on how many people living in large

institutions. The latest data on how many people living in

housing under the Social law is from 2012. These data

shows that approximately 14.000 adults from 18 and up

lives in housing under the Social law. However the size of

these residencies varies from about 6 people living

together to more than 200 living together.

Since 2012 there has been a change in national data-

collection and there is only data from 32 out of 98

Municipalities. An un-published rapport (will be published

later on in the fall) from the Danish Institute For Human

Rights show that around 1/7 of all new-build residence for

people with disability has room for 60 people or more.


Almost all services for people with disability except certain

healthcare services are based at Municipality level. The

residencies under the Social law can be either private or

public, but it is the Municipalities that have the authority

to refer people with disability to housing under the Social

law. There are 98 Municipalities in Denmark. A few

percentages of residencies are based at Regional level.

These are mostly specialised residencies with specialised

services, but it is still the Municipalities that have the

authority to refer to these residencies.


16

14

ENGLAND


Although we have seen the closure of long-stay

institutions, we still have a long way to go to achieve full

independence for people with a learning disability in the

community. Government policy formulated in the wake of

the Winterbourne View scandal reinforces both the policy

on independent living and the personalisation agenda. It is

clear that people should be getting personalised support in

their community. It is recognised that too many people

have ended up in inpatient settings because of a lack of the

right support and services in local communities.

There is now an NHS England led closure programme to

develop the right support and services for people with a

learning disability and behaviour that challenges in the

community and close inpatient units.

The few following legislative act impact the development

of community based care:

- The Care Act 2014 is a new piece of legislation covering

adult social care. It has a focus on wellbeing, prevention

and personalisation. It refers to the UNCRPD and the

guidance says that ‘supporting people to live as

independently as possible is a guiding principle in the Act’.

- The Mental Capacity Act is the law designed to protect

and empower people who may lack capacity to make

decisions. It says that adults have the right to make their

own decisions wherever possible. If they are unable to

make their own decision (because they lack the ’mental

capacity’ to do so) then others may make a best interest

decision for them but the person must still remain at the

centre of any decisions made.

The Deprivation of Liberty Safeguards (DoLS) 2007: These

are part of the MCA and are intended to provide

safeguards for people who lack capacity to consent to the

arrangements for their care and where their support

arrangements are so restrictive that they are considered to

be ‘deprived of their liberty’. The idea is that there are

safeguards in place to ensure such a level of restriction is in

their best interests, properly authorised and monitored.

- Mental Health Act (1983) is the law which sets out when

someone can be admitted, detained and treated in hospital

(inpatient setting) against their wishes.

In February 2015 Simon Stevens, CEO of NHS England,

committed to a closure programme in front of Parliament’s

Public Accounts Committee. This closure plan was

published in October 2015: ‘Building the right support: A

national plan to develop community services and close

inpatient facilities for people with a learning disability and/

or autism who display behaviour that challenges, including

those with a mental health condition’ (NHS England, Local

Government Association (LGA) and Association of Directors

of Adult Social Services (ADASS)).

The key target in the closure plan: Overall, 35-50% of

inpatient beds will close nationally in the next 3 years, with

alternative care provided in the community. To accompany

the closure programme, NHS England, LGA and ADASS

have published a national service model: ‘Supporting

people with a learning disability and/or autism who display

behaviour that challenges, including those with a mental

health condition.’ This sets out the range of support that

should be in place no later than March 2019 .

Budget allocation

There is some funding attached to the NHS England led

closure programme of in-patient beds. (33) It has been

recognised that there are financial disincentives in the

system (for example, if someone is sent to an inpatient

unit, Health will fund the placement (whereas in the

community they may be funded through social care or a

joint package of social care and health. In addition, if

someone is in a secure unit rather than a non-secure unit

then local Health funding doesn’t pay, NHS England

specialist commissioning does). This agenda straddles

health and social care and there are real concerns that the

adult social care system is chronically underfunded. It is

important to be aware of this context.

17


15

Recent announcements (November 2015) by the

government to give local councils more scope for increasing

local taxes (Council Tax) specifically to fund social care, are

not expected to raise anything like the amount of money

claimed.

EU Structural Funds

Progress toward DI

There was a failure over the following 2 years to meet the

target to move people with a learning disability and

behaviour that challenges out of inpatient settings and back

to their local communities by June 2014.

To date little has changed for individuals and their families

(see data on inpatient numbers below). Many families have

been campaigning for a number of years to get their loved

ones out of in-patient settings and supported in the

community, nearer to home. New families continue to

contact support organisations, new petitions are being

launched by families calling on the NHS and local areas to

deliver the changes promised. Their stories are regularly

features in the media. In short, families are still having to

battle to get loved ones out of units.

The Learning Disability Census 2013, 2014 and 2015 have

shown the number of people with a learning disability in

inpatient units and information about their experience in

these settings. This has been a yearly snapshot looking at

data from providers of inpatient care.

Figures from the Learning Disability Census 2015 include:

- the estimated total number of people with a learning

disability in inpatient units is 3,480.

- there are 165 children in inpatient units.

- Of patients receiving inpatient care who were included in

the Census:

- 72% had received antipsychotic medication, yet only

28.5% were recorded as having a psychotic disorder.

- 1,670 had experienced one or more incidents (self-harm,

accidents, physical assault, restraint or seclusion) in the 3

months prior to census.

- Average length of stay in an institution is 4.9 years.

- 670 people are 100km or more from home.



18

16

ESTONIA


Estonia is about to begin the working ability reform, which

will create a new performance of the working ability

support system. (15) The aim of the amendments is to

change attitudes towards people with reduced working

ability and to help them find and keep a job.

Each person with reduced working ability will be

approached individually, assessed on its ability to be active

in the society, and, consequently, helped to find

opportunities in the labour market. Also, a future employer

of the person is dealt with separately, in order to find

labour relationship solutions necessary for both parties.

People with reduced working ability are paid are working

ability allowance . (16) The Reform started from 01.01.16.

By 2020, the public sector will have employed at least

1,000 people with decreased working ability.

The main objective of the new Work Ability Allowance Act

is to preserve a person’s work capacity, activate people

with lowered work capacity, prevent unemployment and

return people to work. (17) The purpose of this Act is to

support employment and access to employment of persons

with reduced work ability caused by long-term health

damage and to ensure an income for them under the

conditions and to the extent provided by law. This Act

establishes the bases for assessment of work ability and

the conditions of and procedure for grant and payment of

work ability allowance.

Strategy

The following general goal has been established for the

Special Care and Welfare Development Plan: ensuring

adult persons with special mental needs with equal

opportunities for self- realisation and high-quality special

care and welfare services that are in line with the

principles of de-institutionalisation.

Three sub-goals have been established to reach the

general goal:

1) adults with special mental needs are ensured with equal

opportunities for self-realisation;

2) special care and welfare services comply with the

principles of de-institutionalisation;

3) special care and welfare services are of high quality and

offered by qualified and professional service providers.

The Strategy of Children and Families for 2012-2020

(hereinafter named as Strategy) and its Action Plan for

2012-2015 constitute an integrated multi-dimensional

policy framework for tackling child poverty and social

exclusion and for promoting child well-being in Estonia.

The objectives of the Strategy together with the

implementation measures and activities focusing primarily

on prevention enable to increase effectiveness of the work

in the area of child and family policy.

The Strategy is also in conformity with the government’s

family policy objectives as well as with development plans

and strategy documents of the Ministry of Social Affairs

and of other government agencies. Synergies between

relevant policy areas and players are guaranteed by

involving more than one hundred experts in the area of

children and families as well as decision-makers at

different levels already in an early stage of the strategy-

making process. However, the success of the Strategy

depends on the provision with resources and improved

capabilities at all levels.

Inclusive education

Special education needs are managed under Ministry of

Education and Research. The state runs schools with visual,

hearing or speech impairment, mobility disability (coupled

with an educational special need), multiple disabilities,

intellectual disability, emotional and behavioral disorders

as well as for students with chronic somatic illness who

need special educational attention. (18)

EU Structural Funds

The DI coordinating structure is the Ministry of Social

welfare.

19


17

Progress toward DI

There are two types of data collection and public

information sources available (unfortunately in Estonian)

about care services and statistics: collected social welfare

data from local authorities and aggregates social welfare

statistics nnd reports, presented by social welfare

institutions. (19) Regarding the types of institutions that

exist, information and data are also available on these

above stated sources.


Estonia is currently in process preparations to create

community based services also for other bigger institutions

for adults, to close large institutions by 2023 .

Training

Professionals working with children in residential care

institutions - their qualifications are indicated by Social

Welfare Act. Foster carers providing home-based care

currently will have to pass only required PRIDE (the only

training program accepted by Estonian government

currently) pre-training. No follow up training is required. Its

performed by voluntary and charitable organizations by

project based means . Training needs and systems for

foster care is currently under re-assessment by

government.


20

18

GREECE


In Greece, one can speak of a “no model” / “no answer”

paradigm. There is a complete absence of a systematic

public approach to mental disability area, to persons with

intellectual disabilities, to persons with autism, to persons

with physical disabilities etc. In Greece there is no de-

institutionalisation strategy in place.

Nevertheless, actions regarding the Psychiatric reform are

included in the Greek Operational Program “Development

of Human Resource 2007 – 2013” (Ministry of Labour,

Social Security and Welfare – Axis 5). The Supported Living

Housing is co-financed both by the Regional Operational

Programs 2007 – 2013 (Greek Prefectures) and Operational

Program “Development of Human Resource 2007 –

2013”.This is a very positive element.

In Greece, the Ministry of Labour, Social Insurance and

Welfare (Directorate Welfare) is responsible for the

Supported Living Housing and the Ministry of Health

(Directorate of Mental Health) is responsible for the

Psychiatric Reform.

According to the texts of the new Operational Programs for

the programmatic 2014 - 2020, which has recently been

approved by the European Commission, only the Regional

Operational Programs (13, one per Region) will be

responsible for the implementation of actions under the

Thematic Goal 9 “promoting social inclusion, combating

poverty and any discrimination” (including actions for

public health, mental health etc.) of the Regulation (EU)

1303/2013 (please refer to article 9 of the above-

mentioned Regulation).

Since February 2014, the role both of the focal point and

the coordination mechanism of the UNCRPD article 33.1

has been assigned to the Directorate of International

Relations/General Directorate of Administrative Support

and e-governance /Ministry of Labour, Social Security and

Welfare. Thus, this Directorate is also responsible for the

monitoring of the implementation of the Article 19 “Living

independently and being included in the community”.

EU Structural Funds

Partnership Framework

In the framework of the obligations derived from the

Memorandum which was signed by the Greek Minister of

Health and the Commissioner of Employment, Social

Affairs and Inclusion Mr. Laszlo Andor, the Thematic Goal 9

“promoting social inclusion, combating poverty and any

discrimination” of the Greek Partnership Agreement states

(on p. 104) that interventions for the finalization of mental

health services and the sensitization and upgrade of skills

of the staff in health area will be promoted as well.

Progress toward DI

People with mental health problems

The Greek Psychiatric reforms began in the early 1980s

with the introduction of the National Health System and

the financial support of the then European Community.

Result: The de-institutionalization of patients from

psychiatric hospitals has almost been achieved. Psychiatric

hospital beds have been reduced, psychiatric units in

general hospitals have been developed, a basic number of

community mental health services has been established.

New legislation has been introduced. However, psychiatric

units in general hospitals and Community Mental Health

Centres have not yet fulfilled their role as principal

providers of psychiatric care, while decentralization,

sectorization and completion of the network of mental

health services has not been completed.

The reform of mental health services in Greece has been

evaluated by various groups of experts over the last

decade. Despite their many positive remarks underlining

the progress accomplished both in policy and in public

attitudes towards mental illness, these reports have

systematically identified a series of structural problems

that were already obvious long before the current

economic crisis. Needless to say, that during the economic

crisis the financing of the bodies of the Psychiatric Reform

program “Psychargos” has decreased significantly.

21


19

These problems include: a) lack of specific data regarding

the budget for mental health within the total health

expenditure, b) the Mental Health Law (1999) and Policy

decisions are not implemented, c) two systems (old

asylums & new community services) are operating in

parallel, d) the services system is fragmented, inconsistent

and lacks coordination d) there are major gaps in service

provision for children and adolescents, e) There is

inequality regarding access to services, with different types

of services in different areas and few areas with a full range

of services, f) The Greek Government is not respecting its

commitments to the European Union that instigated a large

part of the mental health reform policy: this is particularly

true for the “Spidla Agreement” that was signed in 2009 by

the Ministry of Health and the European Commission

regarding: i) continuing to reform the system (closing down

psychiatric hospitals and building networks of services in

the community), ii) providing sufficient funding, iii) putting

into place monitoring and evaluation mechanisms.

In May 2012, a memorandum was signed by the Greek

Minister of Health and the Commissioner of Employment,

Social Affairs and Inclusion Mr. Laszlo Andor, which has

been so far implemented. The following important issues

were foreseen: i) the abolition of psychiatric hospitals until

the 31st of December 2015, ii) the establishment of a viable

new system of providing mental health services also by the

end of 2015, iii) the support and extension of the Social

Created Limited Liability Partnerships (KOISPE) and the

continuation of their funding, iv) the continuation of the

funding of new mental health units in hospitals and of the

not for profit organizations of the private sector until the

31st of December 2015, v) the finding of a definite and

permanent way to finance all these from the 1st of January

2016. These reforms are supported by the Operational

Programme “Development of Human Resources “, Axis 5,

until the end of 2015.



22

20

HUNGARY


Two legislative act refer to community-based care: Act

XXVI of 1998 on the Rights and Equal Opportunities for

Persons with Disabilities and Act III of 1993 on Social

Administration and Social Benefits (Social Benefits Act/

Szoctv.) The government adopted a strategy throught the

Government Decree No. 1257/2011 (VII.21) on the

governmental tasks regarding the strategy and

implementation of the deinstitutionalization of residential

places of social care homes for persons with disabilities.

And the Parliamentary adopted the Resolution No.

15/2015. (IV. 7.) on the National Disability Program (2015-

2025).

Following the decree, the Coordinating Board for

Deinstitutionalization was formed. The priority task of the

Board is to evaluate the incoming implementation studies

for the tender advancing the implementation of the

Strategy, to formulate professional advice on the tenders

based on the aims and principles of the Strategy, to assess

the utilisation concept of the remaining infrastructure after

the changes drawn up in the tenders, to monitor the

developments, to assess the plans of professional trainings

following the process and to oversee their implementation,

to review the capacities of basic services, to ensure full

transparency and to prepare the Action Plan for

Institutional Transformation. Persons with disabilities, the

organizations representing them, social support

institutions, institutions of higher education specialising in

social care and special education, as well as the service

managers participate in the activities of the Board.

Inclusive education

Children with special educational needs are entitled to

receive special educational and pedagogical care

appropriate to their condition within the framework of

special treatment from the date their entitlement was

established. The special care must be provided in

accordance with the opinion of the expert committee.

The parent selects the educational institution appropriate

for the child with special needs based on the opinion,

taking into account the opportunities and needs of both

the parent and the child.

Budget allocation

The subsidy for housing and the budget support for basic

services will be recorded in the budget law: The state

contributions to the operational costs of the particular

social services are included in the subsidies for social

services provided in the budget law. It is significant in

terms of defining the subsidies that which manager is

obliged to perform the specialised task or finance the

particular fund, as well as which manager is entitled to

finance it voluntarily as defined by the law (see Table 1.)

The amount of subsidies depends on the particular target

group the manager provides the particular service to. The

amount of budget subsidies also depends on the type of

the manager that provides the particular social care.

EU Structural Funds

Progress toward DI

23


21

MORE TABLEs



24

22

IRELAND


The Government launched the National Disability Strategy

in 2004 and looked to tie together law and policy in the

area of disability. This was to include existing and future

legislation. (20) The elements of the strategy are:

- The Disability Act 2005: is a law brought in by the

Department of Justice. The Act aimed to: Allow for an

assessment of the needs of people with disabilities and a

service statement; Improve access to public buildings,

services and information; Ensure that certain Government

Departments brought out Sectoral Plans outlining what

improvements that department would take; Place an

obligation on public bodies to be pro-active in employing

people with disabilities; Restrict the use of information

from genetic testing for employment, mortgage and

insurance purposes; Establish a Centre for Excellence in

Universal Design. The Centre would be charged with

developing best practice guidance on how to design, build

and manage buildings and spaces so that they can be

readily accessed and used by everyone, regardless of age,

size, ability or disability.

- The Citizens Information Act 2007: The primary purpose

of the Citizens Information Act 2007 is to provide for a legal

right to advocacy and the establishment of a statutory

advocacy service called the Personal Advocacy Service. The

Personal Advocacy Service would have legal powers to

enter premises and make enquiries on behalf of persons in

residential and day services. Service providers would be

legally obliged to co-operate with the service. Personal

Advocates would have the power to pursue any right of

review or appeal on behalf of the person with a disability.

However, this statutory advocacy service is not yet in

place, and there is no date for its commencement. A

National Advocacy Service was introduced by the CIB in

2011. This service replaced the 46 pilot advocacy projects,

which were funded by the CIB between 2005 and 2010.

The National Advocacy Service does not have statutory

powers and service providers and other agencies have no

legal obligation to co-operate with it.

- The Education for Persons with Special Educational Needs

Act 2004: The EPSEN Act is currently on hold and the key

sections that gave statutory rights to assessment,

education plans and appeals processes for children with

special educational needs have been deferred indefinitely.

EPSEN defines “Special educational need” as a “restriction

in the capacity of the person to participate in and benefit

from education on account of an enduring physical,

sensory, mental health or learning disability, or any other

condition which results in a person learning differently

from a person without that condition”. Under EPSEN, the

following was envisioned as the system to assess children.

However, this system is not yet in place, and there is no

date for its commencement. There are three types of

education provision for children with special educational

needs, mainstream, special classes within mainstream and

special schools. EPSEN says that children should be

educated in an inclusive setting unless this would not be in

the best interests of the child or the effective provision of

education for other children in mainstream education.

The National Housing Strategy for People with a Disability

2011-2016 examines the area of housing and people with

disabilities, including mental health disabilities. It looks at

establishing a framework for the delivery of housing for

people with disabilities through mainstream housing

policy. The Strategy was developed by the Department of

Environment, Community and Local Government, and

launched in October 2011. The stated vision of the strategy

is: To facilitate access, for people with disabilities, to the

appropriate range of housing and related support services,

delivered in an integrated and sustainable manner, which

promotes equality of opportunity, individual choice and

independent living.

EU Structural Funds



Progress toward DI

25


23

People with disabilities

The New Directions report was published in February 2012

and set out a proposed new approach to adult day services

for people with disabilities. This new approach involves

delivering 12 supports, which are collectively called New

Directions. A National Working Group was established to

look at day services. In addition to looking at Irish and

international practices, they conducted a census of day

service users and a consultation with stakeholders. The

review concluded that there was some confusion around

what constituted a day service, and that what was

happening on the ground was diverse and varied.

Children

8 standards were developed and defined differently for

children and adults with disabilities: Child Centered

Services, Effective Services, Safe Services, Health and

Development, Leadership, Governance and Management,

Use of Resources, Workforce, Use of Information. To

ensure a more equitable access to disability services for

children, a national program has been set up to reconfigure

how disability services are delivered in Ireland. This

program takes its lead from the Report of the National

Reference Group on Multidisciplinary Services for Children

aged 5-18, which was published in 2009. It is envisaged

each child will undergo an assessment by a

multidisciplinary team to determine the level of support

they may need. There is acknowledgement that we are

now living in a time of limited financial resources but that

services must live within budget, and use their resources to

achieve maximum benefit for children and families. (21)

It is envisaged that the majority of children with less

complex needs will have their needs met by their local

primary care team. A typical primary care team may include

the following professionals: general practitioners, nurses,

physiotherapists, occupational therapists, social workers,

speech and language therapists and clinical psychologists.

Under the new model, network disability teams will have

the experience and skills to deal with a range of disabilities

including intellectual disability, sensory disability, physical

disability and autism. A typical network disability team

should include professionals such as physiotherapists,

speech and language therapists, occupational therapists,

social workers, clinical psychologists, paediatrician

(sessional), key worker, family support workers and therapy

assistants. These teams may also have the support of a

dietician and orthotist when needed.

Specialist disability team will be provided at a regional level

and specialise in each of sensory disability, intellectual

disability, physical disability and autism as required. These

teams will provide direct service to children with complex

needs on a short term basis, and consultancy to clinicians in

primary and network disability teams. Parents are to be

consulted during the change process. Although, an

assessment is envisaged for each child to determine the

level of service they require, as yet no access criteria exist.

People with mental health problems

Both the Green Paper on Mental Health (Department of

Health June 1992) and the White Paper: A New Mental

Health Act (Department of Health July 1995), which

preceded the Mental Health Act 2001, called for the new

Act to address the obligations of Health Boards (since

replaced by the HSE) to provide access to comprehensive

community-based services. However, the new law mainly

focused on the issues of involuntary detention and

treatment.9 While it also established the Mental Health

Commission and the Inspectorate of Mental Health

Services, the 2001 Act did not contain a framework for the

delivery of mental health services needed to reflect a

community-based, comprehensive and integrated service

as recommended in successive mental health policy

documents and as contemplated by the Green and White

Papers. Although the 2001 Act was a welcome

improvement on the Mental Treatment Acts 1945-61,10

the omission of provisions for community-based services

was criticised by all the main political parties during the

Dáil and Seanad debates . (22) At the end of 2013 there

were five remaining public psychiatric hospitals in service.

These have been replaced with acute psychiatric units in

general hospitals as recommended in A Vision for Change.

Until the remaining psychiatric hospitals are closed, the

staff resource cannot be redeployed to CMHTs.

People experiencing homelessness

The Way Home, the new strategy to address adult

homelessness in Ireland, 2008 to 2013, marks a very

important departure in Government policy on

homelessness. It sets out a vision for the next 5 years,

underpinned by a detailed programme of action, with 3

core objectives:

- eliminating long-term occupation of emergency homeless

facilities;

- eliminating the need to sleep rough; and

- preventing the occurrence of homelessness as far as

possible. (23)

Data: There are more than 4,000 people living in a

congregated setting at present in Ireland.

26

24

LITHUANIA


In 2012 a working group was established by the Ministry of

Social Security and Labour. This working group, which

involves various representatives from NGOs and the

Ministries, prepared de-institutionalisation guidelines,

which were approved and adopted by the Order of the

Ministry of Social Security and Labour in November 2012.

In 2013 there was working group formed for preparing the

Transition Plan from Institutional Care to Community Based

Services for Disabled, Children without Appropriate

Parental Care and Disabled Adults 2014-2020 in Lithuania,

which was approved by an Order of the Minister of Social

Security and Labour on February 14, 2014.

By an Order of the Minister of Social security and Labour of

May 8, 2014 there was interinstitutional monitoring

committee on DeI established for assessment and

monitoring of the process of Transition Plan. It includes 15

members, 9 of those are representatives of NGOs.

Monitoring Committee on DE-I, initiated by the Minister of

Social Security and Labour in May, 2014, has not started

operating yet, although the first De-I pilot project

proposals have been submitted to the ministry by the

Regions (10 Regions in Lithuania uniting several

municipalities) on 1st of October, 2014. On 23th October,

2014, on behalf of the Informal NGO Coalition “For the

Children’s Rrights”, the Ministry of Social Affairs and

Labour was addressed with official letter in order to urge

this process, but received no relevant initiative was

received yet.

The Transition Bureau under the Ministry of Social Affairs

and Labour will be responsible for the implementation of

the Transition Plan from Institutional Care to Community

Based Services for Disabled, Children without Appropriate

Parental Care and Disabled Adults 2014-2020

EU Structural Funds

Lithuania has already provided plans for using SF funding

within the Draft of the Lithuanian Strategy for the use of

European Union Structural Assistance for 2014-2020.

Currently this Draft strategy as well as Partnership

Agreement is being considered by the European

Commision. Nongovernmental organizations has not been

involved in the SF planning process, nor consulted on the

Draft. Ministry of Social security and labour is responsible

for planning the use of SF for the deinstitutionalization

process and activities according the Transition Plan from

Institutional Care to Community Based Services for

Disabled, Children without Appropriate Parental Care and

Disabled Adults 2014-2020 in Lithuania.

While welcoming the objective of using EU funds to

promote the transition from institution to community-

based care, in particular for children and persons with

disabilities, applying NGOs expressed their concern of the

lack of ambition and commitment of the Lithuania

government. The targets set and the indicators used in

their proposal are not considered sufficient in order to

achieve a real change nor a positive progress in promoting

deinstitutionalization in Lithuania. The response was

received that “Commisioner agree that the Lithuanian

authorities have not set their sights sufficiently high as

regards the de-institutionalisation objectives in the draft

operational programmem and wishes to reassure you that

the Commission will raise this important point in the

negotiations with them. And suggestions provided for

indicators and targets will be taken into consideration

when discussing the final version of the operational

programme with Lithuanian authorities”.

Lithuania is using EU Structural Funds to support the

development of mental health services, in particular the

establishment of five crisis intervention centres, five

psychiatric centres for children and family and 27 day care

centres.

Despite the DeI processes, that started at the end of 2012-

2013, Lithuania still has plans for using money from the

previous Structural fund period for the renovation,

construction of the institutional social care settings.

According to the financing programs („Development of

social services within the care and other institutions;

„Development of infrastructure of social services“) of

Ministry of Social security and labour, there are number of

projects foreseen to be funded throughout the years 2014-

2015.

27


25

The main changes regarded decrease of share of children

and persons with disabilities that should be still placed in

institutions in the future and increase of community based

care alternatives developed. Only measures supporting the

transition from institutional to community-based care

should be financed.

There is still no coordinating structure foreseen.

Nevertheless, it is the Ministry of Social Security and

Labour which is taking initiative, since this Ministry is

responsible for all the national institutions of social care

(for children, persons with disabilities, elderly).

Overall responsibility for the administration of the SF

funding is attributed to the Ministry of Finances.

Progress toward DI

Deinstitutionalisation guidelines were approved and

adopted by the Order of the Ministry of Social security and

Labour in November 2012. Subsequently, the Transition

Plan from Institutional Care to Community Based Services

for Disabled, Children without Appropriate Parental Care

and Disabled Adults 2014-2020 in Lithuania was approved

by the Order No. A1- 696 of the Minister of Social Security

and Labour on December 18, 2013. Working group for

preparing both of those documents was established by the

Ministry of Social Security and Labour that involved various

representatives from NGOs and the Ministries.

In general, de-institutionalisation process has been very

slow in Lithuania. Although Lithuanian Government has

declared that they are creating alternatives for the care in

institutions, still institutional form of care prevails in

Lithuania.

Social care services for adults with disabilities in 2012 were

provided by 38 state social care institutions. At the end of

2012, care institutions for persons with disabilities

accommodated 6.1 thousand people, 51,6 percent of those

having mental health problems, and 35,4 percent – persons

with intellectual disabilities, others having complex

disability. On July 2013, there were four social care

institutions providing social care services for disabled

children and disabled young people, the total number of

the accommodated being 654 children. As well there are 5

infant homes in Lithuania that accommodate children from

0 to 3 years old, 327 infants. Historically, state-owned

social care homes (especially for adults with disabilities)

accommodate between 100 and 500 residents.

Lithuanian municipalities are responsible mainly for

development of community based services for people with

psychosocial disabilities, but there are humble signs of

services developed, especially concerning the quality. New

independent living homes in Vilnius and Kaunas cities were

opened recently having a lot of signs of institutional culture

and segregation.

According to the data of Seimas Ombudsmen’s office there

are more than 250 social care institutions for children and

adults in Lithuania, with more than 16 thousand residents.

In total there are 160 residential care institutions for

persons with disabilities, providing long term/ short term

care, covering all age groups (children, adults and elderly).

Whereas according the Statistics department, in 2012 there

were 57 445 thousand persons (elderly and disabled)

receiving social care services, including services at home.

This constituted 22 percent of all disabled persons.

In 2007, Lithuania adopted a National Mental Health

strategy that covers a wide range of principles, priorities

and recommendations. One of the objectives is “De-

institutionalisation and modern services that meet the

needs of the patients.” In 2007 – 2014, no particular steps

were taken towards the implementation of the Mental

Health Strategy, though two Strategy implementation plans

were approved for the period 2007-2010 and 2011-2013.

In 2013 after the suicide of famous Lithuanian actor, the

task force group including 35 members was approved by

the Order of the Minister of Health for the preparation of

the Action Plan for 2014-2017. Organisation of the task

force group was criticized by experts and NGO activists as it

lacked transparency, clear operations, terms of reference

and even constructive dialogues. The Minister of Health

was contacted number of times with particular proposals

formulated by the experts and NGO activists, which were

neglected. The Action Plan was adopted, but no strategic

changes were promoted in Mental Health care system.

The current Mental Health Care Act is valid since 1995.

Throughout the period from 1995 to 2014 it was amended

only once. In 2008 there was provision on obligatory legal

representation included in the law in processes of

involuntary hospitalisation of persons with mental health

problems. No other amendments or changes of legal

framework were in place, which show major reluctance of

the government to apply the modern human rights

standards to the mental health system in Lithuania.

The Mental Health Care Act is under revision in the task

force group established by the Ministry of Health in the

beginning of 2014. No NGO representatives were included

into the task force group initially.

The NGOs express substantial critics regarding crisis

intervention centres, which are established at mental

hospitals, but not in the communities. 20 psychiatric day

care centres were established in the primary health care

level, but services provided there do not include important

psychosocial rehabilitation component.

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26

MOLDOVA


The National Strategy on Child Protection for 2014-2020

(2014) provides a framework of reforms through: ensuring

the necessary conditions for raising children in the family

with a focus on prevention of child-family separation, the

cessation of institutionalisation of children under 3 years of

age; closure of residential institutions; reducing negative

effects of migration of parents on children; supporting

families to ensure optimum development of children. The

Strategy for Social Inclusion of Persons with Disabilities

2010-2013 (approved by Law, 2010) ensures the creation

and functioning of a coherent system for the protection of

children and persons with disabilities, including mental

disabilities, through the provision of a model and methods

for determining the degree of disability, the development

of early intervention services and procedures for the

provision of technical and financial support, as well as

specialised social services.

The Steering Committee on reforming the residential child

care system and developing inclusive education

coordinates the DI process at central level. The district-

level Education Departments and Social Assistance and

Family Protection Departments coordinate the DI process

at local level.

Inclusive education

Program on the development of inclusive education in the

Republic of Moldova for 2011-2020 (2011). (25)

The Program is the national policy on inclusive education

and declares commitment of the state for development

and promotion of inclusive education and for ensuring

equal opportunity and access to quality education for

every child. It highlights the main responsibilities of all

stakeholders involved in development of inclusive

education: national and local authorities, support services,

schools, professionals etc. and designs the inclusive

education management, support/inclusive education

services which have to be created at all levels: national,

local, school . Following, an action plan was adopted.

EU Structural Funds

Progress toward DI

Children

According to a report prepared for UNICEF and the

Ministry of Education, in 2007 there were 11,544 children

living in 67 residential institutions in Moldova. In 2013, the

Strategic review coordinated by the Ministry of Labour,

Social Protection and Family, Ministry of Education and

Ministry of Health, with Lumos’ support, showed that the

number of institutions and number of children placed in

residential care had reduced – there were 3,909 children

living in 43 residential institutions in Moldova.

Figures for 2015 regarding children placed in residential

institutions, though unpublished, are available at the

Ministry of Education.

The proportion of children with special educational needs

(SEN) included in mainstream education has increased

during the last years. Thus, in 2010, only 28.5% of children

with SEN were included in mainstream schools, compared

to 71.5% of children with SEN attending special schools for

children with intellectual or physical disabilities. In 2014,

already 83.3% of children with SEN were included in

mainstream schools, while 16.7% of children with SEN

were still attending special schools. In the school year 2014

-2015, the total number of children with SEN included in

mainstream schools was 7,660 children nationally. (24)

Adults

The Ministry of Labour, Social Protection and Family

(MLSPF) is the coordinator and ensures the proper

functioning of 6 residential social institutions for adults: 2

institutions for elderly and adults with physical disabilities

(somatic profile), and 4 institutions for adults with

psychosocial disabilities (psycho-neurological profile).v

According to data from the Ministry of Labour, Social

Protection and Family, the dynamics of beneficiaries in

residential social institutions subordinated to MLSPF, for

adults, 2009 – 2014, has been the following:

29


27

Types of support


At different stages of implementation of the DI and

inclusive education reforms in the Republic of Moldova,

international organisations and NGOs have supported the

local public authorities (LPA) to assess the availability of

community-based services and facilities within their

respective districts, by mapping of social and educational

services at local level.

The staff working in the social assistance domain are

trained, according to provisions of legal and normative

framework, by the social services providers – the district-

level Social Assistance and Family Protection Departments

– with support from NGOs.


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28

POLAND


Polish legislation (ex. Law on Social Assistance) expresses

an obligation for local government units to provide places

in ex. residential homes and only a possibility to provide

community based alternatives. Lack of clear legislation

reinforcing transition allows for stagnation or very slow

progress in the field. Both the legislation and the system of

social assistance are assessed extremely critically by non-

governmental organisations and persons with disabilities

and their families themselves . (26)

Children

The “Act on Family Support and the System of Foster

Care”, approved by the Polish Parliament in June 2011,

introduces deinstitutionalisation (DI) reforms by preventing

children’s separation from their families and increasing day

care services. The law also forbids institutionalisation of

children under 10. However, due to the lack of foster

families, infants under three years are still placed in

institutions. Larger institutions have been given a seven-

year transitory period.

Despite positive developments, the Polish Government still

has no clear national strategy for DI. The old system of big

institutions for 30 to 70 children still prevails. Moreover,

the system is fragmented with 460 different counties

responsible for institutional care and no effective

monitoring procedure.

Persons with mental health problems

The Mental Health Act was approved in 1994. Until 1994,

there was no definitive legal protection for the rights of

people with mental health disorders. The National

Programme of Mental Health Protection was prepared by

the Institute of Psychiatry and Neurology and was

approved by the Polish Psychiatric Society and the Ministry

of Health in 2006. Ideas included in the National

Programme of Mental Health Protection give hope to many

participants of the mental health system for

transformation towards community-based mental health

care. A significant reduction of psychiatric hospital beds is

planned and consequently daily care units should be

created. Daily care is seen as a better way to increase the

availability and access to mental health services. According

to expert opinions the resources are allocated improperly.

In some places, the availability of mental health services is

very high while in other areas the access is almost blocked.

Great expectations are tied with the idea of the so-called

local mental health centres, which are planned to cover a

population of 200 000. (27)

Protection Programme was implemented between 2011

and 2015. It provided further support for transformation

towards community-based mental health care. Specific

objectives of the Programme included the following

regarding provision of comprehensive and easily accessible

health care and other forms of assistance to people with

mental disorders, necessary to live in the family and

community .

Homelessness

Initial measures were taken in 2012 to improve the shelter

system, and this has developed extensively as reported in

2013 through action taken to design a system of social

services to support transitions out of homelessness (more

below under improvement of service provision). Although

Poland does not yet have a homelessness strategy, it

seems to have laid the foundations for a strategy with clear

standards for the functioning of local services aimed at

homeless people .

Elderly

In the framework of the Operational Programme

Knowledge, Education and Development, (OP KED), a

number of projects will be implemented in the area of

support for the deinstitutionalization of care for dependent

persons, including the elderly, through the development of

alternative forms of care for dependent persons .

Inclusive education

The Act on the Education System provides that any child

may attend any type of school and parents have the right

to decide which type of school is most appropriate.

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29

In practice, however, in spite of the fact that the

mainstream school has a legal responsibility to educate the

child, parents of children with intellectual disabilities

wishing to enrol their child in a mainstream school are

often under pressure from the school to place the child in a

special school.

EU Structural Funds

Progress toward DI

As of 2014 there were altogether 86,119 persons living in

public 24-hour nursing houses, Each year around 11,000

persons are sent to nursing houses, with the number of

persons waiting around 8000. The average number of

persons living in a nursing house, as per 2014, is 106.

The number of full-time nursing homes is still growing

(from 801 in 2012 to 812 in 2014), as is the number of

residents (85,007 in 2012 to 86,119 in 2014). As stated in

the Human Rights Defender report, “the Ministry of Labour

and Social Policy plans to further increase the number of

places in nursing homes .

Outpatient psychiatric facilities including community care

Adults inpatient care

As of 2014 there were 8514 persons living in commercial

nursing institutions, 2709 living in sheltered houses (of

which some hundred are persons with disabilities) and 175

in family nursing homes. The average number of persons

(as of 2014) living in a commercial institution was 24, in a

sheltered house - 4, in a family nursing home .

The number of day care centres is slightly decreasing (230

centres with 19,596 places in 2012 and 226 centres with

19,278 places in 2013), whereas the “number of support

centres is slightly increasing compared with previous

years” (as of 2012: 1,702 centres and 122,569 users; 2013:

1,760 centres and 126,892 users, without distinguishing

persons with disabilities). Also the public nursing and

specialist care services at the place of residence were

experiencing a 2% rise between 2012 and 2013 (with

102,770 persons using this form of aid in 2013).


Access to all these community-based services (ex. care

services and specialised care services provided at a place of

residence, support centres, in particular social self-help

houses, 24-hour residence rooms in social self-help houses

for temporary stay, sheltered housing, family nursing

houses) is very limited. The support for the persons with

little self-reliance who need intensive and specialised

support is particularly inaccessible. Specialised care

services – as a form of individual support at home and in

the local community – are in practice hard to reach,

especially for adults. “The residents of small towns or

villages are in a particularly difficult situation. The support

on offer is the poorest, or is even completely unavailable.

This ends up with the persons in need of support in their

independent life being left without such support, or being

moved to a distant institution”. (28)


Important facts

DI is explicitly mentioned in the Partnership Agreements

(PAs) and the Operational Programmes (OPs)

The ex-ante conditionality not entirely respected

DI is not mentioned in the National Reform Programmes

(NRPs) and National Social Reports (NSRs),

No additional info regarding DI in the Country Specific

Recommendations (CSRs) for each country

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30

SERBIA


DI has been one of the stated objectives of the Serbian

social welfare policy since 2002. While some progress has

been made in relation to children (not so much in relation

to children with disabilities), adults with disabilities still

have very few options other than institutional care.

Relevant policies/legislation include:

- Strategy for the Development of Social Protection (2005):

realisation of a network of community services planned as

one of the goals; Strategy for Improving the Position of

Persons with Disabilities (2007) – DI is not included in the

general goals, but mentioned under specific objectives;

- Strategy and Action Plan for Mental Health Protection

Development (2007) – sets out to establish community-

based services (CBS) for people with mental health

problems, as well as to decrease the number of beds in big

psychiatric hospitals;

- Law on the Social Protection (2011) – most detailed

account of the future DI plans; states that the current

network of institutions should be questioned together with

the services and quality of current institutional placement;

- Law on the Protection of Persons with Mental Disabilities

(May 2013) – criticised by users and their representative

organisations, who have been left out of the drafting

process. (Source: Roadmap on DI)

One key issue is the financing of services in the community,

which are the responsibility of the local self-governments

(unless the municipality is underdeveloped). However, this

decentralisation of responsibility has not been followed by

decentralisation of the budget. This means that local self-

governments have no incentive to bring those currently in

institutions back to the community, where they would be

financially responsible for them. Rather, it is easier for local

self-governments to send people with more complex needs

to the state funded institutions (often far away from where

they come from). A separate issue is the lack of

understanding at the local (and national) level how

community-based services should be developed. (29)

According to the MoLEVSA, the most available services in

the community are the home help for older people and day

care centres. Families of children with disabilities complain

about the lack of early intervention services, fragmentation

of family-support and a tendency for social care services to

replace education for children with disabilities.

The MoLEVSA has recently formed a Working group for the

transformation of social care institutions into a community

services (DI WG). The WG’s task is to monitor and support

DI piloting and to develop a National DI Strategy. At the

same time, the MoH have established a National Expert

Committee for Mental Health with a mandate to evaluate

the possibility and draft recommendations concerning the

transformation (deinstitutionalisation) of psychiatric

hospitals. Coordination between the two Ministries has

been missing. Therefore, the MoH and the MoLEVSA have

set up a joint working group, in order to find solutions in

the fields where cross-sectoral cooperation is needed.

NGOs advocating for deinstitutionalisation have

complained about being excluded or not informed about

the above mentioned working group(s).

Budget allocation

All the social care institutions have a common founder -

the Ministry of Labour, Employment, Veteran and Social

Affairs (MoLEVSA) - except for those located in the

Provincial Region of Vojvodina. They are financed from the

state budget and a part of expenses (health staff) are

covered from the National Health Fund (NHF). In addition

to the running costs, institutions also receive on an

irregular basis investment budgets. Psychiatric hospitals

are established by the Ministry of Health (MoH) and

financed from the NHF. Part of the expenses linked to the

running long term care (more social than health beds) is

covered from state social care budget.

EU Structural Funds

Serbia is a candidate country and does not have access to

SF, but it receives other types of EU funding (such as IPA).

Sustainability of EU funding, with many CBS discontinuing

after the end of funding, has been raised as a problem.

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31

Progress toward DI

Data

There are about 5,500 places in 17 social care institutions,

which accommodate mainly adults with mental health

problems and intellectual disabilities. Four of these are

specialised for people with mental health problems, some

are exclusively for people with intellectual disabilities and

some are mixed. In addition, there are 5 special psychiatric

hospitals with a total capacity of about 3,000 beds (about

half of which are long-term beds). There are about 7,500

beds in social care institutions for older people. The

number of beds in social care institutions has been the

same for a long time. One psychiatric hospital has reduced

the number of beds by 1/3, but the residents were just

moved to other institutions. (30)

According to UNICEF’s TransMonEE database, there are a

total of 3,100 children in residential care (public and

private); 1,485 children with disabilities in public residential

care; 1,566 children without parental care in public

residential care; and 3,404 children without parental care

in family-based care. (Source: TransMonEE; last available

data for 2011, accessed in December 2014). The number of

children in institutions has been reduced in recent years,

but the number of children out of family care is still

growing.



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32

SLOVAKIA


There was a strong move towards DI last year in 2014. The

Government has since changed and the new ruling

government does not seem to be motivated for DI

promotion, but does not show signs to be strongly against.

The Government in general most likely feels they lack

professional capacity, which is why they are involving

relatively open minded professionals as advisors.

There is a DI Strategy and Action Plan but Institutions for

people with mental health problems are not covered by

the above mentioned strategies. (31)

A new Act on social services entered into force on January

2014. A number of significant changes have been

introduced. The Act now stipulates the maximum capacity

for the new residential social service: supported apartment

(zariadenie podporovaného bývania). For supported

apartments, the threshold is max .6 persons in one

apartment and a maximum of two apartments per building

in the case of supported apartment. In addition, the law

does not permit any extension of the capacity of social care

homes. For example, if a social care home has the capacity

for 40 persons – it cannot be increased. New all year

residential social care homes (institutions) can’t be

registered as a social service since 2014.

Day care centre and social care home, working on a weekly

basis cannot provide all year long social service. In

addition, they cannot admit children and young people

under 18 to be in residential social care homes. Finally,

from the finance point of view, for residential institutions

(Domov sociálnych služieb) which wishes to enter in the

process of transformation, the same level of financing will

be maintained and there will be no obligation to meet the

criteria in terms of staff while the number of users may

decrease.

The Ministry prepared and signed in December 2014 a

document entitled ‘National priorities of social services

development for 2015 – 2020’, which is the main

document for the conception of policy in regions and

community plans in municipalities.

There are 4 main priorities:

1.Development of community services

2.DI of social services

3.Development of community services in segregated

regions for marginalized communities (Roma communities)

4.Development and implementation of social services

quality standards at providers level.

Overall, the Strategy is deliberately quite a brief/succinct

document. In principle, it is more of a policy statement

describing the case for DI, stating the latest EU and

international policy developments and Slovakia’s

commitments, the current state of affairs in social services

and children’s care. It gives examples of good practice, but

most of all it focuses on key principles of DI (the substantial

part of the paper) and sets out the main implementing

measures/documents and time frame for their adoption.

EU Structural Funds

DI is a one of priorities of the MLSAF in the field of

children’s care and adults as well. DI is part of OP Human

Resources and OP Integrated regional fund (ERDF). There is

coordinating working group for DI between these two OPs.

From the Ministry of Health there is proposal to include

the DI program in mental health care, but details of these

plans are not known and are not publicly available for

public. Main focus of Ministry of Health in community

services area is now at primary care reform, where they

want to build Integrated health care centers .

Progress toward DI

From 1990 onward, there were a couple of attempts of

transforming social care homes to community based

services (Pohorelská Maša, Hodkovce) made by NGOs (for.

ex. Social Work Advisory Board, Socia Foundation etc.) but

they mostly ended partially done and not part of the social

system .

In September 2007, it became apparent that the Regional

Operational Program (ROP) proved was oriented on

refurbishing of 310 facilities (institutions) and building 30

35


33

brand new facilities. About €180 million from the European

Regional Development Fund (ERDF) was finally invested

into these plans. Investment went mostly to the

institutions with a capacity bigger than 50 clients, without

any real impact on the quality of life of the clients.

Since March 2013, 7 residential institutions have been

included in a pilot national project "Support for the process

of deinstitutionalisation and transformation of the social

services system" supported by ESF. (32)


Social services are provided to 47,400 clients, of which

5103 in a community-based environment.

Slovakia has 320 institutions with a capacity of less than 40

people (6939 clients) and 311 facilities with a capacity of 41

or more (33,919 clients, including elderly people) 12 have a

capacity bigger than 200 clients. Altogether, there are 5

408 adult clients, mostly persons with intellectual

disabilities.

In 2012, there were 14458 children out of family care - 62%

of them in foster of professional foster care, 38% (4 332) in

children’s homes. By law, children younger than 3 cannot

be placed in any form of institutional care.


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34

SLOVENIA


In the field of care for the vulnerable target groups in

Slovenia, the circumstances differ from those in other parts

of Europe. Slovenia is trying to provide for these groups

within its capabilities. However, the closure of institutions

is not possible yet, due to the absence of community-based

services.

Slovenia does not have a coordinator for de-

institutionalization, although in practice implements a

variety of activities, including lifelong learning program

which covers all the stakeholders: users, employees and

their families.

Different actors (Ministries for Labour, Social Affairs and

Equal opportunities, Ministry for Education, Ministry for

Health, local authorities…) are responsible. There is no

permanent coordination structure.

EU Structural Funds

Progress toward DI

Most progress has been made in the field of mental health

(one of the institutions was closed). At the same time there

have been ongoing discussions such as conferences,

roundtables, forums and workshops, on how to move

towards deinstitutionalization in Slovenia. Numerous

undergraduate theses, master's theses and doctoral

dissertations have been written on the topic. The result is a

fast growth of small residential homes and small group

homes, established by both governmental and non-

governmental organizations, often at the initiative and with

the support of parents. These have not been developed in

a systematic way though and parents still prefer to trust

the governmental, as opposed to non-governmental

organizations. Slovenia is still at the stage of further search

for consensus of forms of de-institutionalization, and based

on examples of good practice.

In recent years, person centred planning and person

centred active support have become more common in

service planning. In 2008 Mental Health Act introduced

advocates and community coordinators.

But these breakthroughs have not been sufficiently

monitored and deinstitutionalisation process has not been

implemented comprehensively.

Globally, Slovenia remains an institutionalised country in

comparison to others, with approximately 23 000

institutions residents for 2 000 000 people (of which

approximately 18,000 persons older than 65 years, 4,000

adults with special needs between 18 and 65 years and

1,000 children and youth with special needs under the age

of 18 years) The average ratio of people living in

institutions in Slovenia is 11,5/1000 with those above 65

and 2,5/1000 without elderly to be compared with 2/1000

in the EU.

A Resolution on the national social assistance programme

2013-2020 includes specific quantitative objectives for de-

institutionalisation of adults and the development of new

initiatives, including resettling 2/3 (2800) of the residents

of facilities hosting people with disability and achieve a

balance between institutional and home care for older

people. The implementation of these objectives is made

difficult due to the change of government. It will notably

be linked to the reform to Health Care and Long Term Care

systems, which is currently blocked.

A legal base for financing Personal Assistance is lacking.

Foster care is the norm for children who can stay within

their family. But the situation of children with disability

who are often living in institutions as the only option to be

able to access education is problematic.(660 children with

severe health and special needs live in educational

institutions.)



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38

CONCLUSION

This collection of country fiches provides an insight of the state of play of deinstitutionalisation in different

European countries. While in general it has been acknowledged that progress is taking place, many people still

reside against their will or choice in segregated settings and this needs to be addressed by the European Union

and the Member States. Independent living is a right in the United Nations Convention on the Rights of Persons

with Disabilities and signing parties are under the obligation to enforce it.

There is a current issue being observed in various European countries: the matter of reinstitutionallisation. There

are various reasons for such development to occur. For one, institutions are being closed without having

established community based services first. As a result, people in need of support/care have no other solutions

than going back to institutions. Another reason, is the lack of information and training. Training the professionals

is important. But training the supported person and their families is as important. Someone who has lived their

entire life in institutions would not know how to cope with living in the community and how to enjoy this

independent life. Therefore, it requires to train both professionals and users and families.

The western believe that institutions provide good care and are good for people is still perpetuating. Good care is

not enough, the objective of deinstitutionalisation is to create an inclusive society where no one is sent away in

segregated settings based on the reason that better care is only provided there. Quality of life must be the

criteria when assessing a service/support.

People with specific needs must be empowered and able to make decisions for themselves. Placing them in

institutions inevitably limit their freedom of choice and right to be heard.

Enabling inclusive society and support in the community is not only profitable for the persons in need of support

but also for the society as a whole. Everyone will have the opportunity to be an active citizen participating in the

community life.

To enforce such changes, it is important to act at all levels and areas concerned such as in schools, in the labour

market, in political discussions, in cultural world, in health and social sector, etc. Inclusive society can be reality

and requires a shift in policy but also in the mind of all citizens. Persons at risk of institutionalisation and with

special needs have great capacities and should be supported in appropriate manner in order to be able to be

active citizens and realise their wishes and dreams as all citizens. The use of EU funds should be managed as to

encourage investment in people and not in buildings. Convincing everyone that the transition to community

based care is the right way is not an easy task and forming alliances such as the EEG is a great way of

strengthening our voice.

40

40

References

(1) http://www.esf.at/esf/start-2/esf-2014-2020/ [Accessed: 23rd January 2015]

http://www.oerok.gv.at/esi-fonds-at/efre/ziel-iwb-efre/iwbefre-programm-oesterreich-2014-2020.html

[Accessed: 30th January 2015]

(2) http://www.esf.at/esf/kontakt/esf-koordination/ [Accessed: 23rd January 2015]

(3) http://www.kinderrechte.gv.at/kinderrechte-monitoring/ [Accessed: 19th January 2015]

(4) The members of the Committee are appointed by the Ministry for Labour, Social and Consumer Affairs

with due regard to the proposals by ÖAR. They consist of four representatives of disabled peoples´

organisations, one representative of a non-governmental organization working in the field of human

rights, one representative of a non-governmental organization working in the field of development

cooperation and one representative of academia.

(5) http://lib.ohchr.org/HRBodies/UPR/Documents/Session10/AT/

ANCPD_AustrianNationalCouncilofPersonswithDisabilities_eng.pdf [Accessed: 22nd January 2015]

(6) http://volksanwaltschaft.gv.at/en/preventive-human-rights-monitoring [Accessed: 23rd January 2015]

(7) http://lib.ohchr.org/HRBodies/UPR/Documents/Session10/AT/

ANCPD_AustrianNationalCouncilofPersonswithDisabilities_eng.pdf [Accessed: 22nd January 2015]

(8) http://www.bizeps.or.at/news.php?nr=15186&suchhigh=pers%F6nliche%2Bassistenz [Accessed: 26th

January 2015]

(9) http://www.sozialministerium.at/cms/site/attachments/7/7/8/CH2477/CMS1332494355998/

nap_behinderung-web_2013-01-30_eng.pdf [Accessed: 22nd January 2015]

(10) http://sumero.ba/sumero-publikacije/

(11) http://mlsp.government.bg/index.php?section=POLICIESI&lang=_eng&I=286

(12) http://mlsp.government.bg/index.php?section=POLICIESI&lang=_eng&I=263

(13) The new law envisages support for inclusion of children with disabilities in mainstream kindergartens and

schools to be organized at the level of the kindergartens/schools, including specialize support from

psychologists, speech therapists, resource teachers, etc. Special arrangements are also envisaged to

ensure early identification of children at risk of developmental difficulties at the entrance of the

kindergartens (at 3 years of age) and early intervention.

Number of children with disabilities in kindergartens during the school year 2014/2015: 2789.

Number of children with special educational needs in mainstream schools, school year 2014/2015: 13529.

36

2012/1 2013/1 2014/1

Total 72 71 68

Convalescent schools 10 11 10

Schools for mentally retarded 48 47 46

Schools for hard hearing chil-

dren, visually handicapped

children and speech impaired

children 6 6 6

41


37

(14) http://mlsp.government.bg/index.php?section=POLICIESI&I=275&lang=_eng

http://di-dete.bg/

http://asp.government.bg/ASP_Files/APP/GODISHEN%20OTCHET%20ASP-2015.pdf

http://unicef.bg/en/article/DEINSTITUTIONALISATION-OF-CHILDREN-IN-BULGARIA-HOW-FAR-AND-WHERETO-

Independent-review-of-progress-and-challenges/786

(15) http://sm.ee/en/work-ability-reform)

(16) If, at first, the allowance was supposed to partially decrease after the person earned 641 € per month, according to

the change proposal, the income would begin to decline after the 90-times the daily rate, which in 2016 is 1012.50 €.

Thus, in the future, the working ability allowance will also be paid to people earning an average salary. From this

amount, the allowance will gradually decline, and it will no longer be paid, if the person's income reaches 1,397.25 €.

In case of deficient working ability, the allowance lapses when the person earns 1687.50 € per month. The employer

will be compensated for workplace adjustment costs. As a result of the working ability reform, the disabilities do not

incur additional costs for the employer any more, and people with disabilities are equal employees. The support

provided by the state will create favourable conditions for hiring a disabled person. The Unemployment Insurance

Fund will advise employers, provide support in the period of acclimatisation, and help them find solutions to emerging

issues.

(17) https://www.riigiteataja.ee/en/eli/502042015015/consolide)

(18) Map of schools: https://www.hm.ee/en/activities/pre-school-basic-and-secondary-education/special-educational-

needs

(19) S-veeb (https://sveeb.sm.ee/index.php?tid=xlZs6i7psUEjYsRjEkhhZhhhhhhhhLh0sj7I)

H-veeb (https://hveeb.sm.ee/index.php?tid=spMJKMCauu7sBOodrrMNpL0I)

(20) http://www.inclusionireland.ie/sites/default/files/documents/information_pack-final.pdf

(21) http://www.inclusionireland.ie/sites/default/files/documents/information_pack-final.pdf p.31

(22) http://www.amnesty.ie/sites/default/files/Legislating%20for%20Change.pdf p.11

(23) http://www.environ.ie/en/Publications/DevelopmentandHousing/Housing/FileDownLoad,18192,en.pdf

(24) Situaţia copiilor în Republica Moldova în anul 2014 / The situation of children in the Republic of Moldova in 2014.

(Data from the National Bureau of Statistics). Available online in Romanian: http://www.statistica.md/newsview.php?

l=ro&id=4779&idc=168

(25) HOTĂRÎRE Nr. 523 din 11.07.2011 cu privire la aprobarea Programului de dezvoltare a educaţiei incluzive în Republica

Moldova pentru anii 2011-2020 / Government Decision no. 523 of 11.07.2011 regarding the approval of the Program

on the development of inclusive education in the Republic of Moldova for 2011-2020. Available online in Romanian:

http://lex.justice.md/index.php?action=view&view=doc&lang=1&id=339343

(26) Law of 12 March 2004 on Social Assistance, uniform text Journal of Laws 2009.175.1362.

Realisation of the obligations arising from the UN Convention on the Rights of Persons with Disabilities by Poland -

Report of the Human Rights Defender for years 2012-2014, p. 46; The Human Rights Defender (in Polish: Rzecznik

Praw Obywatelskich; translated also as Ombudsman or Commissioner for Human Rights) is the Polish constitutional

authority for legal control and protection in the field of human rights.

(27) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908346/

(28) Alternative Report on the Implementation of the UN Convention on the Rights of Persons with Disabilities, available

at: http://konwencja.org/english/

(29) Open Arms Project and EEG Seminar Report

(30) Open Arms Project, Summary of situation concerning institutional care and its transformation to inclusive –

community based care, 2014.

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(31) http://www.employment.gov.sk/files/legislativa/dokumenty-zoznamy-pod/strategia-deinstitucionalizacie-

systemu-socialnych-sluzieb-nahradnej-starostlivosti-1.pdf (only in Slovak)http://

www.employment.gov.sk/ files/legislativa/dokumenty-zoznamy-pod/narodny-plan-

deinstitucionalizacie_en.pdf (in English)

(32) Project implementation period 01/2013 – 11/2015 & Budget: 1 000 000,00 EUR. The project aims to

initiate and support the process of deinstitutionalisation of social services, as well as prepare and verify a

single procedure deinstitutionalisation of social services for people with disabilities and mental health

problems.

(33) £45m from NHS England to support transformation of support and services. This includes:

£30 million to support local areas with transitional costs (with national funding conditional on match-

funding from local commissioners).

£15 million capital funding over 3 years

‘Dowries’ for people who have been in units for 5 years or more (CCG/ NHS England money to LA for

‘resettlement’ out of hospital and into a more suitable home).

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